Specifications include, but are not limited to: Scope A – LTSS Enrollment Services: The Contractor shall provide LTSS nursing facility level of care assessments and determinations to determine if an individual meets functional eligibility criteria for nursing facility services or home-and-community based waiver services. The Contractor shall also be responsible for the Preadmission Screening and Resident Review (PASRR) for all nursing facility admissions to Medicaid certified nursing facilities. Additionally, the Contractor shall provide intake counseling, which is counseling regarding MLTSS and PACE and choice of setting, to those potentially eligible for LTSS. Lastly, this scope includes assistance with the Medicaid application for long-term care for those requesting this service; this is included as optional in the Scope of Work, as such the State may choose to exclude this from the final Scope of Work, depending on pricing and budget. Scope B – Member Support Services: The Contractor shall assist MLTSS members with navigating their MLTSS plans and providing education, when requested by the member. The Contractor shall also assist enrollees to address Issues with MCEs and aid members with the Grievances and Appeals process. The Contractor shall monitor the inquiries received from members and report potential or systemic problems to the State.
